The Reduction of Infant Mortality in Illinois - Fiscal Year 2016

The Family Case Management Program and Special Supplemental Nutrition Program for Women, Infants and Children 2016 Annual Report

Table of Contents

• Executive Summary
• Introduction
• Program Descriptions
• Financing
• Service Delivery System
• Performance

1. Enrollment in Both FCM and WIC
2. First Trimester Enrollment in FCS
3. Breastfeeding Exclusivity in WIC
4. Three or More Well-Child visits to FCM Infants Before Age One
5. Fully Immunized Infants in FCM
6. Health Insurance Coverage of Infants and Children in FCM
7. Developmental Screening of Infants and Children in FCM

• Outcomes

1. Very Low Birth Weight

• Racial Disparities in Infant Mortality: The Persistent Challenge
• Conclusion

EXECUTIVE SUMMARY

Illinois' infant mortality rate for calendar year 2013 was 6.0 deaths for every 1,000 live births. In calendar year 2014, the rate was 6.06 deaths for every 1,000 live births. In calendar year 2013, the absolute number of infant deaths was 942. In calendar year 2014, it was 1,044.

The Illinois Department of Human Services (IDHS) helps to reduce this loss through the integrated delivery of the Family Case Management (FCM) program and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). These programs combined served an average of 36 percent of all infants and 76 percent of Medicaid-eligible infants born in Illinois in calendar years 2013 and 2014. IDHS supplements these statewide programs with targeted services such as Better Birth Outcomes (BBO) for women whose chances of giving birth prematurely are greater than average and, as a result, their infants have a higher risk of dying before their first birthday.

Program Success - IDHS monitors the performance of the FCM and WIC programs on several short-term health status indicators. At the end of the State Fiscal Year 2016 (SFY2016), the performance on each indicator included the following: 1) Eligible children up to age 13 months who received FCM and had health insurance was 88.2 percent; 2) 85 percent of all infants in FCM were fully immunized; 3) 9.6 percent of all infants who received WIC were breastfed exclusively at 12 weeks; 4) 88.7 percent of children who received FCM also received at least three well-child healthcare visits from a medical professional during the first year of life; 5) 89.3 percent of infants and children in FCM received a developmental screening from a FCM; and 6) women and infants who received both FCM and WIC was approximately 93 percent.

Racial Disparities in Infant Mortality - The overall infant mortality rate in Illinois has declined by 27 percent since the inception of IDHS in 1997. Despite this, a significant and continued disparity in infant mortality rates persists between African American and Caucasian infants. IDHS and various organizations are creating interventions designed specifically to reduce racial disparities in healthcare and health outcomes. The interventions include an increased focus on care of highest-risk pregnant women through the Better Birth Outcomes (BBO) program; a campaign to reduce elective late preterm deliveries; and an improved Perinatal Health Care system, which include hospitals with the capacity to serve high-risk deliveries. Breastfeeding is a significant determinant of infant health. Illinois is in the forefront of promoting breastfeeding initiation and exclusivity via WIC's Peer Counselors who help women initiate and continue breastfeeding. Enhancement of services directed to preventing very low birth weight such as Better Birth Outcomes holds significant potential for lowering the disparity between African American and Caucasian infant mortality rates and Illinois' overall infant mortality rate.

Improved Health Status - For the past 19 consecutive years [since calendar year (CY) 1997], infants born to Medicaid-eligible pregnant women who participated in both FCM and WIC are in better health than those born to Medicaid-eligible women who did not participate in either program. In CY2013, the rate of very low birth weight was 42 percent lower than that among non-clients and the rate of premature birth was over 21 percent lower. In CY2014, the rate of very low birth weight was over 52 percent lower than that among non-clients and the rate of premature birth was almost 30 percent lower. For both calendar years, the very low birth weight rate was also significantly lower (i.e., 13.6 percent and 30.9 percent, respectively) than the general population who received no Medicaid services from IDHS Division of Family and Community Services (DFCS).

Fiscal Savings - In addition to the improved heath statuses listed above (i.e., health benefits afforded by FCM and WIC), Illinois' investment in these programs between calendar year 2010 and 2015 have saved the state an average $166 million each year in Medicaid expenditures. In calendar year 2014, Illinois saved $190 million in Medicaid expenditures. Those expenses for healthcare in the first year of life were almost 9 percent lower among dual-program clients than among non-clients in CY2013 and in CY2014 expenses were over 16 percent lower. These expenses are lower, in part, due to fewer births in Illinois. The number of births in Illinois is over 11 percent lower in calendar year 2014 than it was in 2005.

INTRODUCTION

For purposes of this report, the recipients of Family Case Management (FCM), BBO (Better Birth Outcomes), and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services will be referred to as clients.

Illinois' infant mortality rate for calendar year 2013 was 6.0 deaths for every 1,000 live births. In calendar year 2014, the rate was 6.6 deaths for every 1,000 live births. In calendar year 2013, the absolute number of infant deaths was 942. In calendar year 2014, it was 1,044.

Table 1:  Actual Number of Illinois Infant Deaths (Calendar Years)

Calendar Year	Number of Illinois Infant Deaths	Infant Mortality Rate
2010	1,116	6.8
2011	1,062	6.6
2012	1,032	6.5
2013	942	6.0
2014	1,044	6.6

Source: http://dph.illinois.gov/data-statistics/vital-statistics/infant-mortality-statistics

Many factors contribute to the state's infant mortality rate. Medical and pharmacological treatments, such as antibiotics and newborn genetic testing, are available to diagnose and treat conditions that used to take the lives of infants who were born prematurely. Illinois' success in maternal and child health services is due in part to the Illinois Department of Human Services' ongoing collaborative efforts with both the Illinois Department of Public Health (IDPH) and Illinois Department of Healthcare and Family Services (IDHFS).

Consecutive "Reduction of Infant Mortality" reports demonstrate that participation in both the Family Case Management (FCM) program and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy substantially improves infant health. This improvement contributes an estimated annual savings of over $166 million in Medicaid expenditures for care required during the first year of life. Additional savings from avoided special education, disability, and rehabilitation support service costs potentially accrue over a lifetime. According to the American Academy of Pediatrics, common conditions that occur in premature infants include infection, hernias, Respiratory Distress Syndrome (RDS), Chronic Lung Disease, Retinopathy of Prematurity (blindness), Jaundice, and heart murmurs.

PROGRAM DESCRIPTIONS

IDHS administers a Maternal and Child Health (MCH) strategy for the reduction of infant mortality. The strategy integrates two large-scale programs, the Family Case Management (FCM) program and Special Supplemental Nutrition Program for Women, Infants, and Children, more commonly known as WIC. Under FCM is another element of the MCH strategy; the Better Birth Outcomes (BBO) program. BBO targets geographic areas of the state where data indicates higher rates of premature births in the Medicaid population. See Figure 2 for the most recent map showing the areas of need. Pregnant women deemed at risk of having an adverse birth by the assessment are encouraged to enroll in the BBO program, which ultimately may decrease costs, improve health outcomes, and decrease morbidity and mortality in pregnant women and infants.

The integration of these programs is supported and enhanced by the shared use of Cornerstone, IDHS' Maternal and Child Health management information system. This system collects and reports all information necessary for the operation of the FCM, BBO, and WIC programs. Cornerstone provides an integrated record of the services provided to each client and a comprehensive care plan that identifies the services the family requires. This avoids the problem of duplicative data collection and recording. Cornerstone promotes integration and streamlines the delivery of MCH services.

Family Case Management (FCM) is a statewide program that provides comprehensive Maternal and Child Health services. The IDHS funds 104 agencies, including local health departments, community-based organizations, and Federally Qualified Health Centers (FQHCs) to conduct FCM activities. Assessments are conducted and care plans developed to address a wide range of needs including: healthcare, mental health, educational, vocational, childcare, transportation, psychosocial, nutritional, environmental, developmental, and other services. Contacts with mothers or guardians and their infant/child include home and office visits at a frequency determined by program-required minimum standards, case managers' clinical judgment, and the expertise and knowledge of the clients' needs and situation.

Better Birth Outcomes (BBO) is a more intensive care coordination program directed exclusively to the needs of high-risk pregnant women. During January 2013, the Better Birth Outcomes program began in 22 communities throughout Illinois. The program distinguishes high-risk women from those of lower-risk with the use of a standard risk screening tool. A Registered Nurse or Master's trained Social Worker, provides each client with standardized prenatal education; utilizing the March of Dimes' Becoming a Mom curriculum. Care coordination among medical and social service providers is the hallmark of the program. Communication mechanisms between prenatal care providers and BBO care coordinators are in place. Interfaces among the state's large information systems (i.e., Medicaid Claims, Vital Statistics, and Cornerstone) alert care coordinators of at-risk women, inform the care providers and coordinators of the services delivered, and report performance in terms of services delivered and pregnancy outcomes.

Clients receive nutrition education, counseling, referrals to healthcare, and supplemental foods. The food "prescriptions" are based on nutritional needs and include fruits, vegetables, whole grains, milk, cheese, eggs, adult and infant cereal, juice, peanut butter, beans, tuna, salmon, and infant formula. The tailored food prescriptions are printed on food instruments on-site for eligible women at WIC clinics statewide. Clients obtain their WIC foods by redeeming the food instruments at program-approved grocery stores throughout the state and at WIC Food and Nutrition Centers in certain areas of Chicago. The IDHS authorizes funds to 98 local agencies to provide WIC services, including local health departments, not-for-profit healthcare agencies, and social service agencies. All WIC staff members are trained to support and promote breastfeeding. Over half of WIC agencies have additional funding for the WIC Breastfeeding Peer Counselor Program (BPCP). The use of Breastfeeding Peer Counselors adds a critical dimension to WIC's efforts to help women initiate and continue breastfeeding. WIC's Breastfeeding Peer Counselors provide a valuable service to their communities by addressing the barriers to breastfeeding through the offering breastfeeding education, support, and role modeling. Breastfeeding Peer Counselors are familiar with the resources available to women enrolled in WIC, have familiarity with the questions a new breastfeeding mother may ask, and recognize when to refer mothers to other resources during critical periods when mothers experience difficulties.

FINANCING

Illinois' integrated Maternal and Child Health program for the reduction of infant mortality is supported by a combination of state and federal resources. The State Fiscal Year 2012 (SFY2012) through SFY2016 expenditures by program component are presented in Table 2.

Table 2:  Expenditures for Integrated Infant Mortality Reduction Strategy by Program Component and State Fiscal Year

Program	WIC (all sources)	FCM	BBO	Total
SFY2012	$296,525,189	n/a	n/a	$296,525,189
SFY2013	$290,754,192	$33,467,706	$1,561,583	$325,783,481
SFY2014	$287,274,871	$32,302,082	$4,080,993	$323,657,946
SFY2015	$290,813,937	$30,986,166	$5,375,754	$327,175,857
SFY2016	$261,709,909	$20,128,139	$2,625,592	$284,463,640

Note: IDHS initiated Better Birth Outcomes (BBO) in 22 communities in January 2013. Expenditures as presented in Table 2 for calendar year 2013 reflect one half year's support. Expenditures not available for FCM for SFY2012.

The FCM program is supported by the General Revenue Fund, the Title V - Maternal and Child Health Services Block Grant, and the Title XX - Social Services Block Grant. Local health departments also add their own funds for the operation of the program. Further, local health departments may receive federal match for the local funds they expend in support of the FCM program. Each year this increases the total amount of funds available to local health departments. Those match funds in turn are used to augment their funding for FCM.

WIC is funded by the U.S. Department of Agriculture (USDA) with both food funds and Nutrition Services Administration (NSA) dollars, which provide for WIC nutrition assessment, education, counseling, and referrals. NSA funds are granted to local WIC providers based on an estimated caseload. An infant formula rebate contract is required by the USDA, which supplements the WIC food funds. Rebates added over $69 million to the WIC program's food budget for SFY2016.

SERVICE DELIVERY SYSTEM

Family Case Management (FCM), Better Birth Outcomes (BBO), and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programs are delivered at the community level by grantees of IDHS. Most often, these are local health departments although community health centers and community-based organizations also play an integral role in the delivery of primary and preventive care to pregnant women, mothers, infants, and children.

Local Health Departments. Local Health Departments (LHDs) in Illinois have a unique responsibility and are accountable to the public for the health of the entire community to assess needs, develop policy, and address problems. Local health departments provide Maternal and Child Health services within their jurisdictions.

Community Health Centers. Community Health Centers (CHCs) and Federally Qualified Health Centers (FQHCs) in Illinois provide a complete array of primary health care services in medically under-served communities. Several are IDHS grantees for Family Case Management, WIC, and other programs. Examples of CHCs include, Erie Family Health Center, Near North Health Services Corporation, Aunt Martha's Youth Services, Chicago Family Health Center, and VNA of Fox Valley. These entities continue to be partners in the Better Birth Outcomes program as well as FCM and WIC.

Community-Based Organizations (CBOs). A Community-Based Organization is one that is driven by community residents in all aspects of its existence. Local residents may staff and govern the organization. They are often located in the center of the community they serve. Collaborating with community-based organizations enables our FCM and WIC organizations to educate and heighten awareness about FCM and WIC. These organizations bring an extensive knowledge of the communities they serve, are familiar with the cultural diversity of their communities, and employ staff who remain sensitive to community needs, beliefs, and cultures.

CASELOAD

The number of clients served by the FCM and WIC programs between SFY2012 and SFY2016 is presented in Table 3. The WIC and FCM caseloads have declined in recent years. The decrease is in part due to lower birth rates. See Figure 1 on page 4.

Table 3:  Total Number of Clients Served in FCM and WIC Programs by Program and SFY 

SFY	2012	2013	2014	2015	2016
FCM	266,635	252,234	233,694	222,098	192,189
WIC	520,557	503,237	488,400	469,265	430,028

 Source: Cornerstone

Table 4 represents a breakdown of WIC and FCM clients served in SFY2016. FCM does not keep a separate count of the number of participating postpartum or breastfeeding women. Under USDA guidelines; however, these women comprise a separate category of eligibility for the WIC program.

Table 4: Number of Clients Served in FCM and WIC Programs by Type of Client and Program - SFY2016

Type of Client	Program
	FCM*	WIC
Pregnant Women	66,490	79,547
Postpartum and Breastfeeding Women	NA	50,260
Infants (up to 12 months of age)	106,395	143,373
Children (1 to 5 years of age)	19,304	156,848

Source: Cornerstone

*FCM does not have a category of postpartum or breastfeeding women

The FCM and WIC programs together reach over 36 percent of all infants and over 76 percent of Medicaid-eligible infants born in Illinois in calendar years 2013 and 2014. Women who are at high risk for giving birth prematurely or having a baby with other health problems are receiving benefits from these programs as these programs are intended to function.

As shown in the Tables 5a and 5b, the FCM and WIC programs are having an impact on different demographic groups. For example, African-American infants made up 17.5% of the live births in Illinois in calendar year 2014; however, 63.0% of all of those infants born in Illinois in calendar year 2014 were covered by the FCM or WIC programs. Given that there is a racial disparity in the infant mortality rate, serving a higher percentage of African-American clients in the two programs than is represented by the community helps to address that disparity.

Teenagers (age 10-19) had 6.8% of all of the live births in Illinois in calendar year 2014; but 74.8% of all of those infants born to teenagers in Illinois in calendar year 2014 were covered by the FCM or WIC programs. Teenage pregnancy and birth is by definition of the FCM and WIC programs a high-risk event. The FCM and WIC programs are designed to reduce that risk.

Demographic Group Live Births

 All FCM or WIC Clients

Table 5a:  Number and Percent of All Live Births and Live Births to FCM or WIC Clients by Demographic Group, Illinois Calendar Year 2013

Demographic Group	Number	Percent	Number	Percent	Percent of Group
Caucasian	116,701	74.4%	35,365	62.6%	30.3%
African American	27,326	17.4%	17,568	31.1%	64.3%
Asian American, Native American, & all others	12,891	8.2%	3,597	6.3%	27.9%
All Live Births	156,918	100.0%	56,527	100.0%	36.0%
Select demographic groups found to be at higher risk
Hispanic/Latino	33,439	21.3%	18,675	33.0%	55.8%
Single	63,273	40.3%	42,500	75.2%	67.2%
Teenage	10,634	6.8%	7,949	14.1%	74.8%

Source: IDPH Vital Records and IDHS Cornerstone via the IDHFS Enterprise Data Warehouse (EDW)

Demographic Group Live Births

Table 5b:  Number and percent of All Live Births and Live Births to FCM or WIC Clients by Demographic Group, Illinois Calendar year 2014

Demographic Group	All		FCM or WIC
	Number	Percent	Number	Percent	Percent of Group
Caucasian	117,900	74.40%	34,510	55.60%	29.30%
African American	27,775	17.50%	17,510	28.20%	63.00%
Asian American, Native American, & all others	12,847	8.10%	10,069	16.20%	78.40%
All Live Births	158,522	100.00%	62,089	100.00%	39.20%
Select demographic groups found to be at higher risk
Hispanic/Latino	33,784	21.30%	18,347	29.50%	54.30%
Single	63,521	40.10%	41,604	67.00%	65.50%
Teenage (Age 10-19)	9,684	6.10%	7,121	17.10%	73.50%

Source: IDPH Vital Records and IDHS Cornerstone via the IDHFS Enterprise Data Warehouse (EDW)

CY 2015 live birth and infant death data is not available to IDHS at the time of this report. The information provided is the most current available as of November 1, 2017.

PERFORMANCE

Program performance is measured against several short-term health status indicators among women, infants, and children enrolled in FCM, WIC, or both programs, which include:

1. Enrollment in both FCM and WIC
2. Enrollment in FCM within first trimester
3. Achievement of breastfeeding exclusivity in the infant's first 12 weeks in WIC
4. Achievement of continued breastfeeding (exclusive or partial) at 6 months of age
5. Contact by a Breastfeeding Peer Counselor (BFPC) in the infant's first week of life by BFPC-funded agencies
6. Completion of three or more well-child visits with a medical professional to FCM infants before age one
7. Determination of full immunization of infants in FCM
8. Verification of health insurance coverage of infants and children in FCM
9. Assessment of developmental screening status of infants and children in FCM

IDHS uses its management information system, Cornerstone, to analyze and generate quarterly reports on these performance measures. Agency performance provides the basis for ongoing technical assistance. These reports can be found at https://www.dhs.state.il.us/page.aspx?item=31152 for provider and public access.

1. Enrollment in Both FCM and WIC

Since 1998, IDHS has promoted the integration of FCM and WIC services. Continuing evaluations have shown that Medicaid-eligible women, who participated in FCM and WIC during their pregnancies, have had substantially lower rates of premature birth and infant mortality.

Figure 3 entitled "Program Integration of WIC and FCM SFY2012 to SFY2016" displays the proportion of clients in one program who are also enrolled in the other program. For example, the line labeled 'WIC' shows the proportion of WIC clients also enrolled in FCM. At the end of Fiscal Year 2016, almost 91 percent of WIC clients were receiving FCM services and almost 95 percent of FCM clients were receiving WIC services.

2. First Trimester Enrollment in FCM

Enrollment in FCM services during the first trimester of pregnancy is essential to ensure maximum impact on the health of the mother and newborn infant. Figure 4 entitled, "Prenatal Clients' First Trimester Enrollment in FCM SFY2012 - SFY2016," shows there has been a relatively steady rate over the last several years in the proportion of program clients who enrolled in the FCM programs during the first trimester of pregnancy. The chart seems to show seasonality in the enrollment, with the lows occurring in the summer months. This coincides with the normal school year for school-age children, which probably shows the need for child care to enhance enrollment in the program.

Local FCM agencies use a variety of strategies to reach low-income families in the communities they serve. The Better Birth Outcomes program places strong emphasis on first trimester enrollment in the program. BBO agencies are required to develop and implement formal outreach plans and maintain monthly logs of their outreach activities. These activities may include door-to-door canvassing, distribution of printed materials, use of mass media, as well as nontraditional methods that may be necessary to identify potential clients in hard-to-reach populations (e.g., persons who abuse drugs or engage in prostitution). BBO agencies are expected to have linkage agreements for referrals from all medical providers within their target services areas.

IDHS also takes advantage of its computer technology to increase the proportion of Medicaid-eligible pregnant women who enroll in FCM and improve the proportion of women who enroll in the first trimester of pregnancy. Local FCM service providers are linked indirectly to IDHS' Family Community Resource Centers (FCRCs) through an electronic data exchange. Each month, information about pregnant women who have enrolled in the Medicaid program is transferred from the Client Information System used by the Family Community Resource Centers to the Cornerstone system. The information is then distributed to local service providers and is ultimately used to conduct targeted outreach efforts.

3. Breastfeeding Exclusivity in WIC

Breastfeeding is a significant determinant of infant health. Illinois is in the forefront of promoting breastfeeding initiation, exclusivity, and duration. Effective January 2013, the Hospital Infant Feeding Act (HIFA) made Illinois the first state in the nation to require that all birthing hospitals adopt a policy promoting breastfeeding.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about the first 3 months (12 weeks) of a baby's life followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby. Figure 5 below entitled "WIC Clients' 12 Week Breastfeeding Exclusivity SFY2014 - SFY2016" displays the proportion of women who participated in the WIC program during pregnancy and exclusively breastfed their infants for 12 weeks after giving birth. The rate of breastfeeding exclusively among WIC clients remained steady in SFY2016.

In the WIC program, Breastfeeding Peer Counselors (BFPCs) help women initiate and continue breastfeeding. BFPCs are mothers who have personal experience with breastfeeding and are trained to provide basic breastfeeding information and encouragement to new mothers. BFPCs are familiar with the resources available to WIC clients, have familiarity with the questions a new breastfeeding mother may ask, and recognize when to refer mothers to other resources during critical periods when mothers may experience difficulty.

BFPCs are recruited and hired from WIC's target population of low-income women and undergo training to provide mother-to-mother support in group settings and one-on-one counseling through telephone calls or visits in the home, clinic, or hospital. Representing diverse cultural backgrounds, they offer encouragement, information, and support to other WIC mothers. Most women stop breastfeeding in the early weeks. To move the exclusivity of breastfeeding goal forward, BFPCs are responsible for making contact at least twice in the infant's first week of life to provide support and encouragement in this critical period. Tracking this measure began in 2015 as depicted in Figure 6.

4. Three or More Well-Child Visits to FCM Infants Before Age One

The American Academy of Pediatrics (AAP) and Healthy People 2020 recommends routine FCM well-child visits with a medical professional. Providers monitor a child's growth and development, provide preventive healthcare services (i.e., immunizations), screen for potentially serious health problems (i.e., lead poisoning or problems with vision or hearing), and inform parents through anticipatory guidance. Both organizations recommend six such visits during the first year of life, to occur at one month, two months, four months, six months, nine months, and twelve months of age.

IDHS monitors FCM providers to ensure that participating infants receive at least three well-child visits during the first year of life. Figure 7 below entitled "FCM-Eligible Infants with Three or More Well-Child Visits" displays the proportion of infants who met this standard.

5. Fully Immunized Infants in FCM

According to Healthy People 2020, vaccines are the most cost-efficient and effective way to prevent childhood disease and mortality. Figure 8 shows the proportion of children between 12 and 18 months of age who were active in FCM services and had received:

• 3 doses of diphtheria, pertussis, and tetanus vaccine;
• 2 doses of oral polio vaccine; and
• 2 doses of Haemophilus influenza type B vaccine.

6. Health Insurance Coverage of Infants and Children in FCM

Health insurance is essential for access to health care services. Virtually every infant who receives FCM services is, by definition, eligible for the state of Illinois' All Kids program. IDHS has been working with IDHFS to increase the proportion of FCM-eligible children who are also enrolled in All Kids if they are not covered by their parents' health insurance. Local FCM agencies have been trained and certified by the IDHFS as "All Kids Application Agents." Local FCM program staff persons assist eligible families in applying for coverage through All Kids.

7. Developmental Screening of Infants and Children in FCM

HealthyChildren.org (in association with the American Academy of Pediatrics) states that infants and young children (i.e., ages 0 to 4) should be screened routinely for evidence of delays in cognitive, linguistic, motor, social, and emotional development. Through routine screenings developmental delays can be promptly identified and therapy initiated for the infant or child. IDHS monitors the proportion of infants in the FCM program who have been screened for issues associated with physical and/or cognitive developmental delays at least once a year. Figure 10 entitled, "FCM Developmental Assessment at 12 Months of Age - SFY2012 - SFY2016" displays the proportion of 12-month-old children in FCM screened for developmental delays at least once since birth.

OUTCOMES

Illinois' integrated strategy for improving maternal and child health focuses on four outcomes that reduce:

• Very low birth weight rate
• Premature birth rate
• Medicaid expenditures during the first year of life
• Infant mortality rate

Very low birth weight infants (i.e., newborns who weigh less than 3 pounds 2 ounces) require intensive medical care. While these infants represent less than two percent of all live births, they also account for two-thirds of the infants who die in the first year of life. Interventions that reduce the very low birth weight rate will also reduce Medicaid expenditures during the first year of life and reduce the infant mortality rate.

The integrated delivery of FCM and WIC affects the state's infant mortality rate and health care expenditures. The health status of infants born to Medicaid-eligible women who participated in both FCM and WIC has been substantially better than that of infants born to Medicaid-eligible women who did not participate in either program. The analysis performed on the CY2013 and CY2014 birth data consistently reflected in both years that the rate of premature birth is over 25 percent lower among clients in both programs; in addition the rate of very low birth weight is over 50 percent lower; and Medicaid health care expenditures during the first year of life are almost 10 percent lower.

Very Low Birth Weight

The very low birth weight (VLBW) rate of infants for women who were in Medicaid, FCM, and WIC was 1.28 percent in CY2013, just under one-half the rate of women who received only Medicaid services during pregnancy (2.22 percent).

In CY2014, the VLBW rate of infants for women who were in both Medicaid, FCM, and WIC was 1.09 percent, just over one-half the rate of women who received only Medicaid services during pregnancy (2.43 percent).

Even more remarkable is the fact that the VLBW rate of infants for those women receiving Medicaid and on both FCM and WIC in CY2013 and CY2014 was more than 13 and 30 percent lower, respectively, than the rate for those women who received no benefits at all. The rate of VLBW of infants within the general population, who received no services, was 1.49 percent in CY2013 and 1.58 percent in CY2014.

Infant Mortality

As reflected in the graph below entitled "Infant Mortality Rate", when looking at the linear trend line, Illinois has made steady progress in reducing its infant mortality rate (IMR). Despite instances where the IMR has risen slightly above the line or fallen slightly below the line, Illinois has continued to make progress on improving the IMR rate, although slowly.

RACIAL DISPARITIES IN INFANT MORTALITY: THE PERSISTENT CHALLENGE

Figure 13 below entitled, "Infant Mortality by Race in Illinois by Calendar Year" presents the CY2014 infant mortality rates of African American, Caucasian, and Illinois' entire population. The rate among African Americans, while the lowest on record, continues to be at an unacceptably high level of 12.6 deaths per 1,000 live births.

Over the last 25 years, from 1990 to 2014, the overall infant mortality rate in Illinois has declined by 44 percent. Despite this, a significant disparity in infant mortality rates persists between African American and Caucasian infants (See Figure 13.) An African American infant born in Illinois during calendar year 2014 was 2.3 times more likely to die before reaching his/her first birthday compared to a Caucasian infant.

This disparity is not acceptable and IDHS staff is evaluating data to determine potential new strategies to address it. Special projects within the IDHS Division of Family and Community Services' Bureau of Maternal and Child Health include:

• A Best Practices in Interconception Health program, which is available to women with a prior poor outcome within Cook County. A prior poor outcome is considered a woman who has experienced a fetal or neonatal loss within certain categories.
• Partnership with the Illinois Perinatal Quality Collaborative.
• Participation in the Illinois Home Visiting Task Force.

CONCLUSION

As reflected in the SFY2016 Reduction of Infant Mortality in Illinois Annual Report, there is a wealth of data to indicate that Illinois' infant mortality reduction programming is working to improve outcomes for low income families. Mothers, infants, and children on Medicaid who participate in FCM and WIC present better birth outcomes than those receiving Medicaid only. Prevention programming aimed at both individuals and communities is not only saving lives but also conserving limited resources. Health service indicators such as immunization rates, well-child visits, and breastfeeding exclusivity are higher than in the recent past due to the concerted efforts of FCM and WIC clients, providers, and administrators. IDHS and other health and human services agencies will continue to strive to improve outcomes with particular focus on the African American infant mortality rate, which remains higher than that of other racial groups.